Healthcare Provider Details

I. General information

NPI: 1790370344
Provider Name (Legal Business Name): MELISSA GHIGLIOTTY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 SW 46TH CT STE 210
OCALA FL
34474-5786
US

IV. Provider business mailing address

4500 NEWBERRY RD
GAINESVILLE FL
32607-2245
US

V. Phone/Fax

Practice location:
  • Phone: 352-620-1980
  • Fax:
Mailing address:
  • Phone: 352-336-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA30677
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: